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What's Causing All That Skin Redness?

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Photo: Claire Benoist

Red has never signified calm and tranquility. So when it's the shade your skin has taken on, whether all over or in smaller patches, you need to act: "Redness is an indication that there's inflammation in the skin and blood is rushing in to try to heal it," says Joshua Zeichner, M.D., the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. The redness may be minor at first and easily covered with foundation, but like a smoldering fire, if you ignore it, things will escalate.

For one thing, chronic redness—and the ensuing inflammation—makes "skin age much faster," says Julie Russak, M.D., a dermatologist in New York City. "Inflammation
not only destroys your stores of skin-plumping collagen but also hampers the production of new collagen, so it's a twofold insult," she says. It can also cause permanent dilation of blood vessels over time, which gives skin that ruddy look.

Figuring out exactly what's got you red in the face can be tricky, though. Redness is skin's default reaction to any number of conditions. But the three most common are rosacea, sensitivity, and allergies. These guidelines will help you single out the source and restore your complexion to beautiful.

Rosacea

What to watch for: In its early stages, skin flushes intensely and persistently when you eat spicy or hot foods, drink alcohol or hot liquids, exercise, are in extreme hot or cold temperatures or the sun, or feel stressed or nervous. (See: 5 Skin Conditions That Get Worse with Stress) Of course we all get a little flushed after a workout, but with rosacea, it comes on fast and furious and may bring a burning or stinging sensation. "Triggers that shouldn't upset skin do, and they cause a reaction beyond what you'd normally expect," Dr. Zeichner says.

As rosacea persists, frequent and intense increases in blood flow may weaken blood vessels—like a rubber band gone lax from being stretched too much—and other changes may cause the condition to progress. Skin could then look more crimson overall. It may also become inflamed, and you might see small, pimple-like bumps. These symptoms tend to worsen with age. (Related: Lena Dunham Opens Up About Struggling with Rosacea and Acne)

What causes rosacea: The condition, which affects about 15 million Americans, according to the National Rosacea Society, is mostly driven by genetics, says Ranella Hirsch, M.D., a dermatologist in Cambridge, Massachusetts. It's most prevalent in the fair-skinned, but people with darker skin tones can develop it too. In fact, because natural skin pigment can mask some of the early pinkness, those with darker skin tones may not realize they have it until it's gotten worse and the redness is very noticeable.

Multiple factors likely play a role in causing rosacea. "We know that the nerves overfire, which overstimulates blood vessels to dilate," Dr. Zeichner says. People with rosacea also seem to have higher levels of pro-inflammatory peptides called cathelicidins in their skin, which may overreact to certain stimuli and unleash a major and unwarranted inflammatory response.

What to do: If you suddenly start flushing, see a dermatologist or your doctor to make sure you don't have an underlying blood pressure issue, Dr. Hirsch says. Try keeping a diary of flushing episodes to pinpoint your personal triggers so you can avoid them. And be especially gentle with your skin, Dr. Zeichner says. Stop using scrubs, peels, and other drying, exfoliating, or fragranced products, all of which can make skin like yours even redder.

Also, consider asking your dermatologist about Rhofade. The new Rx cream's active ingredient targets cell pathways responsible for dilating the skin's blood vessels and constricts them for 12 hours, says Arielle Kauvar, M.D., a dermatologist in NYC. It can regulate the flow of blood to skin, almost like installing a low-flow showerhead. Lasers are still the most effective and long-lasting treatment for flushing (three or four sessions can eliminate layers of visible, overactive blood vessels), but Rhofade offers a more immediate alternative. The two have shown promise when used in tandem.

Sensitive Skin & Skin Allergies

What to watch for: Skin feels tight or raw after you apply products (even mild ones) or in response to environmental factors like extreme weather and wind. Fair skin will look red and irritated, while darker skin tones may develop dark spots and pigmentation over time. Both skin types may become flaky and dry and may have redness, Dr. Russak says, with all symptoms potentially worsening midway through your menstrual cycle, when progesterone surges.

What causes sensitive skin and skin allergies: While aspects of your skin-care routine may be to blame (a hypersensitivity to a specific ingredient, for example), some people have a weaker skin barrier and their skin is naturally more reactive, Dr. Russak says. The term skin barrier refers to skin cells and a fatty substance between them that acts as a mortar to cells' bricks. It's the gatekeeper that holds water in and keeps irritants out. When it's weak, water escapes and molecules in the environment or in products can penetrate more deeply. Your body senses an attack and launches an immune response, which triggers irritation, inflammation, and the increased blood flow you see as redness.

What to do: Abandon your products—especially those with fragrance (one of the most common skin allergens)—and switch to cleansers and moisturizers with ingredients known to shore up the skin barrier, such as ceramides, and soothing and cooling aloe vera gel. (Here are 20 vegan products made to soothe sensitive skin.)

And try to keep stress in check: A review in the journal Inflammation & Allergy—Drug Targets found stress can affect barrier function, making skin drier and potentially more sensitive. (Try this 10-minute trick to de-stress.)

 

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